Pediatric emergency medicine fellows’ milestone evaluations: Do they all meet the targets for graduation?

Abstract

Background The ACGME Milestone Project created a competency‐based trainee assessment tool. Subcompetencies (SC) are scored on a 5‐point scale; level 4 is recommended for graduation. The 2018 Milestones Report found that across subspecialties, not all graduates attain level 4 for every SC. Objective To describe the number of pediatric emergency medicine (PEM) fellows who achieve ≥level 4 in all 23 SC at graduation and identify SC where level 4 is not achieved and factors predictive of not achieving a level 4. Design/Methods This is a multi‐center, retrospective cohort study of PEM fellows from 2014‐2018. Program directors provided milestone reports. Descriptive analysis of SC scores was performed. Sub‐analyses assessed differences in residency graduation scores, first year fellowship scores, and the rate of milestone attainment between fellows who did and did not attain ≥level 4 at graduation. Results Data from 392 fellows were obtained. There were no SC in which all fellows attained ≥ level 4 at graduation; the range of fellows scoring < level 4 per SC was 7‐39%. 67% of fellows did not attain ≥level 4 on one or more SC. While some fellows failed to attain ≥level 4 on up to all 23 SC, 26% failed to meet level 4 on only 1 or 2. In 19 SC, residency graduation and/or first year fellow scores were lower for fellows who did not attain ≥level 4 at graduation compared to those who did (mean difference 0.74 points). Among 10 SC, fellows who did not attain ≥level 4 at graduation had a faster rate of improvement compared to those who did attain ≥level 4. Conclusion In our sample, 67% of PEM fellows did not attain level 4 for ≥1 of the SC at graduation. Low scores during residency or early in fellowship may predict difficulty in meeting level 4 by fellowship completion.